An increase in the percentage of women suffering pelvic organ prolapse is suspected as life expectancy and the rate of obesity is increasing. Non-surgical treatment options of pelvic organ prolapse consist of pelvic floor muscle training, lifestyle adjustments, application of local estrogens and the use of a pessary. In the past, the impact of pessaries on symptoms of pelvic organ prolapse was mostly assessed by questionnaires on quality of life and sexual dysfunction.

This study is the first study to look at the possibility to perform adequate measurements of the pelvic floor with transperineal ultrasound with a pessary in situ and whether a pessary changes the functional anatomy of the pelvic floor.

This pilot study is designed as a monocentric cross-sectional study with a population of 20 patients who are about to start or already using a pessary to treat their symptomatic pelvic organ prolapse. A paired samples t-test will be executed. A p-value below 0,05 is considered statistically significant.

Only 13 patients were included due to the COVID 19 pandemic. Anterior compartment prolapse could be assessed in 12 of 13 patients. In 3 patients, hypermobility of the urethra was present without a pessary. However, with the pessary in place, the hypermobility disappeared. Significant anterior compartment prolapse was present in 3 patients, but none while the pessary was in situ. Statistically, a significant difference is found for bladder neck descent at maximal Valsalva maneuver and bladder neck difference with a p-value of 0,002. The central compartment could only be assessed in 5 patients. No significant difference in rectal ampulla descent was found.

Imaging of the pelvic floor and assessment of especially the anterior pelvic organ prolapse with a pessary in place is possible with transperineal ultrasound. Initial findings show an immediate improvement of the pelvic floor anatomy. The assessment of the cervix or vault when the pessary is in place is difficult because of the acoustic shadow of the pessary and because the echogenicity of the cervix or vault is similar to the surrounding tissue. Assessment of the central and posterior compartment failed to demonstrate a significant difference.

An increase in the percentage of women suffering pelvic organ prolapse is expected. Pessaries are a good non-surgical treatment option. However, extensive scientific research on their effectiveness is still lacking.  This pilot study shows that imaging of the pelvic floor and assessment of especially the anterior POP with a pessary in place is feasible with transperineal ultrasound. Initial findings show an immediate improvement of the pelvic floor anatomy.